LIVRE JDG 2010

with posterior cruciate or collateral ligament

injury were excluded from the study (n=40).

Fifty-four patients (n=57 knees) with isolated

ACL injury without surgical reconstruction

were identified. Range of motion, Inter-

national Knee Society Score (IKS) [9] were

recorded at a preoperative visit and at the

most recent follow-up (24 months minimum

follow-up). The need for revision TKA surge-

ry, and any complication were noted for each

patient. The study group included 32 men

(n=32 knees) and 22 women (n=25 knees,

three bilateral), ranging in age from 53 to 85

(mean 71 years ± 9). The Body Mass Index

(BMI) of patients ranged from 16 to 35 (mean

27 ± 4). There were 37 right and 20 left knees.

Patients that had an arthroscopy such as for a

meniscal tear were included (n=3).

A cohort of control patients (n=57 knees) mat-

ched for patient age, sex, surgeon, date, and

implant that had not previously undergone ipsi-

lateral knee surgery or with prior ligament inju-

ry were selected from our total joint registry.

Only patients who underwent primary TKA for

the diagnosis of degenerative osteoarthritis

were selected to serve as controls. Patients with

posttraumatic or inflammatory arthritis were

excluded. Revision knee arthroplasty surgery,

diagnosis of infection, postoperative range of

motion, IKS knee and function scores were

recorded for both the study and control groups.

Radiographs for patients were reviewed.

The implant used for TKA was selected by the

surgeon at the time of the arthroplasty proce-

dure. All patients underwent a HLS posterior-

stabilized prosthesis (T

ORNIER

, St-Ismier,

France) which is routinely used in our hospital

for a standard TKA. All components were

cemented. The patella was resurfaced in all

cases. The procedures were performed by the

same surgical team with identical surgical

technique in all cases.

The clinical assessment was performed preo-

peratively and postoperatively with a mini-

mum two-year follow-up. The IKS score was

used for all clinical examination. We assessed

IKS category, IKS Score

(Knee Score and

Function scores)

and range of motion. The

radiological assessment was performed preo-

peratively and at least 24 months postoperati-

vely. Antero-posterior, lateral, patellar and

long leg films X-rays were assessed for radio-

lucent lines (RLL) and measurements of the

implant axes. The alignment of the knee was

measured before and after surgery as the hip-

knee-ankle (HKA) angle.

STATISTICALANALYSIS

Outcome measures, such as Knee and

Function IKS Scores, extension, flexion,

recorded at the most recent follow-up (but

before a revision of the TKA) were compared

using a 2-sample T-test assuming unequal

variances. Significance was defined as a P value

less than 0.05.

RESULTS

The mean length of time from ACL injury to

TKAwas 34 ± 12 years (15-58). The mean age

at the time of TKA was 70.6 ± 9 years (53-85

years) in the study group and 73 ± 7 years (53-

93 years) in the control group (p=0.1).

At the time of the surgery, the tourniquet time

was 77 ± 19 in both groups (p=0.9). A medial

release (pie-crusting of medial collateral liga-

ment (MCL), MCL distal release or semi

membranosus release) was performed in

31 patients of study group and 35 patients of

control group (p=0.5). A posterior release was

performed in 13 patients of study group and

15 patients of control group (p=0.7).

In three cases of the study group there was

bone loss of the tibial plateau. In each case this

was a dished-form deficit of the posteromedial

tibia (cupula). The deficit was drilled and

filled with cement in two cases and one case

requiring a medial tibial metallic wedge

(fig. 1). No bony defects were observed in the

control group.

JOURNÉES LYONNAISES DE CHIRURGIE DU GENOU

308